Provider Demographics
NPI:1881895019
Name:WALTERS, VICKY ANN (MSW)
Entity type:Individual
Prefix:
First Name:VICKY
Middle Name:ANN
Last Name:WALTERS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2513 SW ASHWORTH PL
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66614-2505
Mailing Address - Country:US
Mailing Address - Phone:785-213-2342
Mailing Address - Fax:785-233-6707
Practice Address - Street 1:2513 SW ASHWORTH PL
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66614-2505
Practice Address - Country:US
Practice Address - Phone:785-213-2342
Practice Address - Fax:785-233-6707
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLSCSW 12821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS046693Medicare ID - Type Unspecified